Documente Academic
Documente Profesional
Documente Cultură
No. 06-2156
COUNSEL
ARGUED: Jeffrey Alan Holmstrand, MCDERMOTT & BONENBERGER, P.L.L.C., Wheeling, West Virginia, for Appellant. Daniel
C. Cooper, Bridgeport, West Virginia, for Appellee. ON BRIEF:
Jamison H. Cropp, STEPTOE & JOHNSON, Clarksburg, West Virginia, for Appellee.
OPINION
TRAXLER, Circuit Judge:
This appeal involves a dispute between two insurance companies,
with each company claiming that the insurance provided by its policy
was "excess" to the other insurance and that its coverage therefore
was not triggered until the limits of the other companys policy were
exhausted. The district court granted summary judgment in favor of
Horace Mann Insurance Company, concluding that its policy was
excess to the policy issued by General Star National Insurance Company. General Star appeals. We reverse the decision of the district
court and remand for entry of judgment declaring the General Star
policy excess to the Horace Mann policy.
I.
A West Virginia high school student was sexually abused by a
teacher, and the student filed suit against numerous defendants,
including the school board and the school principal. The parties settled the claims for an amount in excess of $1,000,000.
West Virginia law requires the State Board of Risk and Insurance
Management to provide a minimum of $1,000,000 of liability insurance coverage for all county school boards and their employees. See
W. Va. Code 29-12-5a. The board must also provide a minimum of
$5,000,000 in excess liability insurance coverage. See id.
In this case, the statutorily required first layer of liability insurance
was provided by National Union Fire Insurance Company, and the
$5,000,000 in excess liability coverage was provided by General Star.
National Union contributed its policy limits to the settlement of the
students claims, and General Star, as excess insurer, contributed the
balance of the settlement amount.
The General Star policy at issue in this case is a typical excess policy. The policy describes itself an excess liability policy, see J.A. 25
("Certificate of Excess Insurance"), and the declarations on the first
page of the policy include a listing of the required underlying insurance and define the coverage as limited to occurrences where liability
is "in excess of the limits" of the underlying insurance, J.A. 25. The
policys insuring agreement likewise clearly defines the coverage as
excess in nature. See J.A. 31 ("The Company shall indemnify the
insured for ultimate net loss in excess of the underlying insurance
stated in Item 2 of the Declarations, but not in excess of the Companys limits of liability stated in Item 3 of the Declarations.").
The Horace Mann policy is an "educators employment liability"
policy issued to the school principal by virtue of his membership in
the National Education Association. J.A. 16. It provides for
$1,000,000 of coverage per member per occurrence for claims other
than civil rights claims; $300,000 of coverage for civil rights claims;
reimbursement of up to $35,000 for attorneys fees incurred in successfully defending a criminal action; and $1,000 bail bond premium
reimbursement. Whether the policy is a primary or excess policy is
a matter of some dispute that we will address in detail later in the
opinion. For the moment it suffices to say that the policy appears to
provide first-dollar, primary liability insurance coverage for the specified risks.
B.
Under certain circumstances, a primary liability insurance policy
may in fact provide only excess liability coverage. Because multiple
insurance policies may cover a given loss, liability insurance policies
generally contain "other insurance" clauses that attempt to define the
insurers responsibility for payment when other insurance coverage is
available. These clauses typically take the form of a pro-rata clause,
an escape clause, or an excess clause. A pro-rata clause "limit[s] the
insurers liability to its pro rata share of the loss in the proportion that
its policy limits bear[ ] to the aggregate of available liability coverage." State Farm Mut. Auto. Ins. Co. v. U.S. Fidelity & Guar. Co, 490
F.2d 407, 410 (4th Cir. 1974). An escape clause provides that the
insurer will have no liability to the insured when other insurance coverage is available, while an excess clause provides that the insurer
will be liable only after the exhaustion of the limits of any other applicable insurance. See id.; see also 15 Russ & Segalla, Couch on Insurance 219:5.
A primary liability insurance policy that contains an excess otherinsurance clause thus effectively operates as an excess policy if other
insurance is available. That is, even though the policy would provide
primary, first-dollar coverage for an insured loss if no other insurance
policy covered the loss, it will provide excess coverage when other
insurance is available. Primary liability policies with excess otherinsurance clauses are sometimes referred to as "coincidental excess"
policies. See Firemans Fund Ins. Co. v. CNA Ins. Co., 862 A.2d 251,
266 (Vt. 2004) ("[C]oincidental excess insurance is primary insurance that is rendered excess by operation of a policy provision, like
an other insurance clause, in a specific set of circumstances.").
Other-insurance clauses are generally valid and enforceable, see 15
Russ & Segalla, Couch on Insurance 219:3, and the clauses are easy
enough to interpret and apply when only one policy with an otherinsurance clause is involved. Interpretation and application of the
clauses, however, may be quite difficult in cases where multiple liability policies potentially provide coverage for a given loss and each
of the policies contains an other-insurance clause. For example, if two
potentially applicable policies both contain an escape clause, application of the clauses as written could leave the insured without any liability coverageeach insurer could point to the existence of the other
policy and claim that its escape clause relieved it of any obligation
under the policy. And in cases where both policies contain excess
other-insurance clauses, each insurer will contend that its otherinsurance clause makes it excess to the other and that the other policy
must therefore provide primary coverage. In such cases there typically
is no language in either policy that gives a court a contractually-based
way to decide which policy should be excess to the other. Cf. Employers Reinsurance Corp. v. Phoenix Ins. Co., 230 Cal. Rptr. 792, 798
(Cal. Ct. App. 1986) ("If we were to give effect to all three excess
clauses in this instance, they would cancel each other out and afford
the insured no coverage whatsoever. We would travel full circle with
no place to say the buck stops here."). Given the prevalence of
other-insurance clauses, it is not surprising that "the books are replete
Horace Manns other-insurance clause also provides for pro-rata contribution in the event there is some other excess policy to which the Horace Mann policy would not be considered excess.
clear its intention to always be excess when other insurance is available, the Horace Mann policy was not required to contribute to the
settlement of the underlying tort claims until the limits of the General
Star policy were exhausted. And because payment of the underlying
settlement did not exhaust General Stars policy limits, the district
court granted summary judgment in favor of Horace Mann.
C.
We turn now to General Stars challenge to the district courts
decision. General Star argues that its policy is a true (or pure) excess
policy that only provides excess coverage and never provides primary
coverage. Horace Manns policy, by contrast, provides primary liability coverage that in some cases will convert to excess coverage by virtue of the other-insurance clause. General Star contends that the rules
generally governing conflicts between other-insurance clauses do not
apply when one of the policies at issue is a true excess policy and the
other policy is a primary liability policy. Instead, General Star contends that priority disputes between a true excess policy and a primary
policy with an excess other-insurance clause are always resolved in
favor of the true excess policy.
(1)
"True excess" or "pure excess" is a description used to distinguish
typical excess liability policies from coincidental excess policies
policies that provide primary liability coverage but operate as excess
in a given case because of an other-insurance clause. See Gauze, 633
S.E.2d at 333 (concluding that policy was not a "pure excess" policy
because it "provide[d] the first layer of insurance coverage, unless
there was some other coverage"); see also Sherlock v. Ocean Salvage Corp., 785 So. 2d 932, 937 (La. App. 2001) ("In resolving conflicting other insurance clauses it is important to distinguish
between policies that are true excess policies and those that are actually primary policies with excess other insurance clauses." (internal
quotation marks omitted)).
There is no question that General Stars policy is a true excess policy. As the terms of its insuring agreement make clear, coverage
under the General Star policy is dependent upon the exhaustion of the
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As mentioned above, the Horace Mann policy provides for reimbursement for a bail bond premium and reimbursement for attorneys fees
incurred in a successful defense against criminal charges. It seems
unlikely that such coverage would be provided by the other insurance
that might be available to Horace Mann policy holders, such as the statutorily mandated insurance for school boards, or homeowners insurance.
Thus, it may well be that the Horace Mann policy would provide primary
coverage in these areas even when other insurance exists. See 15 Lee R.
Russ & Thomas F. Segalla, Couch on Insurance 219:14 (3d ed. 2005)
("It is generally held that in order for an other insurance clause to operate
in the insurers favor, there must be both an identity of the insured interest and an identity of risk. . . . The rule that the risks be identical in order
for an other insurance clause to apply does not mean that the total possible coverage under each policy be the same, but merely that with
respect to the harm which has been sustained there be coverage under
both policies." (footnotes omitted)).
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National Farmers Union Prop. & Cas. Co. v. Farm & City Ins. Co.,
689 N.W.2d 619, 624 (S.D. 2004); LeMars Mut. Ins. Co. v. Farm &
City Ins. Co., 494 N.W.2d 216, 218-19 (Iowa 1992); Atkinson v.
Atkinson, 326 S.E.2d 206, 214 (Ga. 1985).
This rule applies without regard to the terms of the policies otherinsurance clauses, because other-insurance clauses are an issue only
"when two or more policies apply at the same level of coverage. An
other insurance dispute can only arise between carriers on the same
level[;] it cannot arise between excess and primary insurers." North
River Ins. Co., 257 Cal. Rptr. at 132 (citations and internal quotation
marks omitted); see Allstate Ins. Co. v. Frank B. Hall & Co. of Ca.,
770 P.2d 1342, 1347 (Co. Ct. App. 1989) (declining to require prorata contribution where other-insurance clauses were mutually repugnant, because that "rule has generally not been applied when one of
the clauses is contained within what would otherwise be a primary
policy . . . and the other is contained within a policy that is designed
to be an excess or umbrella policy"); 15 Russ & Segalla, Couch on
Insurance 218:5 ("An other insurance dispute cannot arise
between primary insurers and true excess insurers."). Accordingly, in
a priority dispute between a true excess insurer and a primary or coincidental excess insurer, the policies other-insurance clauses simply
are not relevant, and there is no reason to consider whether the otherinsurance clauses may be reconciled or must be set aside as mutually
repugnant. See General Star Natl Ins. Co. v. World Oil Co., 973 F.
Supp. 943, 949 (C.D. Cal. 1997) ("When a policy is excess to another
policy, there is no need to analyze the other insurance clauses in
either of the policies. Because an excess or secondary policy, by its
own terms, does not apply to cover a loss until the underlying primary
insurance has been exhausted, an examination of other insurance
clauses to determine the relative rights and responsibilities of the parties is unnecessary where the policies do not provide the same level
of protection." (citation and alteration omitted)); National Farmers
Union Prop. & Cas. Co., 689 N.W.2d at 624 (concluding that true
excess policy was last in priority of payment even though the primary
insurance policy had a broad other-insurance clause: "Competing
other insurance clauses . . ., which normally would invoke contract
construction rules, must yield to a finding of the insurance policies
main functions."); accord National Sur. Corp., 260 F.3d at 884;
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Even without Allstate, we would predict that West Virginia would follow the true-excess-is-always-excess rule. Horace Mann does not dispute
the substance or wisdom of the general rule, but argues only that the rule
does not apply to this case. And while the rule is frequently described as
being the majority rule, Horace Mann does not point to any case where
a court has rejected the rule. Cf. Monroe Guar. Ins. Co. v. Langreck, 816
N.E.2d 485, 492-93 (Ind. App. 2004) (characterizing the true-excess-isalways-excess rule as a "practically universal rule in jurisdictions that
have addressed the issue"). Moreover, the rule is advocated by the
authors of the leading treatises on insurance law, see 15 Russ & Segalla,
Couch on Insurance 218:5 ("An other insurance dispute cannot arise
between primary insurers and true excess insurers."); 8A John A. Appleman & Jean Appleman, Insurance Law and Practice 4909.85 (1981)
("Umbrella coverages, almost without dispute, are regarded as true
excess over and above any type of primary coverage . . . ."), treatises to
which the West Virginia Supreme Court has looked for guidance when
resolving insurance issues, see, e.g., West Virginia Fire & Cas. Co. v.
Mathews, 543 S.E.2d 664, 670 (W. Va. 2000) (citing Couch); Erie Ins.
Prop. & Cas. Co. v. Stage Show Pizza, JTS, Inc., 553 S.E.2d 257, 262
(W. Va. 2001) (citing Appleman and Couch).
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Horace Mann also argues that the primary policy in Allstate was
always intended to provide primary coverage (except when a nonowned vehicle was involved), while its policy, as evidenced by the
language in its other-insurance policy, "can never be primary7 to any
other policy," Brief of Appellee at 17, and "was always intended to
provide excess coverage," id. at 22. Though couched in terms of distinguishing Allstate, Horace Manns argument is more of a challenge
to the characterization of its policy as a primary liability policy or a
coincidental excess policy. In any event, the argument is without
merit.
Horace Mann is probably correct that there is a factual difference
between its level of exposure and the level of exposure in Allstate of
the garage policy insurer, whose policy limits we concluded must be
exhausted before the true excess insurer could be required to contribute. That is, the issuer of the garage operations policy in Allstate
likely would have expected that most claims under the policy would
trigger its primary coverage obligations rather than the excess covera recognition that the insured might buy secondary excess insurance
insurance that operates as excess to General Stars excess policy. See
National Farmers Union, 689 N.W.2d at 623 (concluding that otherinsurance clause contained in true excess policy which stated that the
policy would not be excess to "insurance bought to apply in excess of the
retained limit of liability plus the limit of liability of this policy" referred
to a third layer of insurance coverage); Allstate Ins. Co. v. Frank B. Hall
& Co. of Ca., 770 P.2d 1342, 1347 (Colo. Ct. App. 1989) (concluding
that "the reference in the umbrella coverages excess clause to a policy
that is specifically stated to be in excess of that policy refers to a third
tier of insurance that treats the umbrella coverage as underlying insurance and specifically refers to that coverage. This proviso does not refer
to primary liability insurance that merely has a standard excess clause.").
That General Star contemplated the possibility of another true excess
policy being excess to its coverage does not mean that it contemplated
that a policy providing primary coverage would be excess to its policy.
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We also note that in no event is Horace Mann providing primary liability coverage in this case; primary coverage was provided under the
National Union Fire Insurance Company policy. The question in this
appeal is whether Horace Mann or General Star must bear responsibility
for the amount of the settlement in excess of the limits of the primary
insurance.
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lion policy to settle the parents claim, and General Star National
Insurance Company ("General Star"), the school boards excess carrier, contributed a portion of its $5 million excess coverage to the settlement. This action addresses whether General Star has a right to
obtain reimbursement from Horace Mann Insurance Company
("Horace Mann"), which had underwritten an insurance policy covering members of the West Virginia Education Association personally,
including the school principal in this case.
The district court, considering the language of both the General
Star policy and the Horace Mann policy, concluded that the "other
insurance" provisions of the two policies were reconcilable and
accordingly applied them so that the Horace Mann policy was excess
over the General Star policy. The court noted that the language of the
Horace Mann policy specifically defined its coverage to be excess
over the General Star policy and that the General Star policy explicitly accommodated this order of coverage, providing that it was not
an excess policy over another policy that provided it was an excess
policy over the General Star policy.
I agree with the district courts common sense reading of the plain
language of the two policies and its conclusions that they are not in
conflict. Therefore, I conclude that no extra-contractual insurance
principles developed to resolve conflicts among policies need to be
applied to determine the order of their coverage.
II
Rather than applying the language of the policies, the majority
attempts to assign the policies at issue to generalized classifications
and then to apply general rules of court-made law to resolve conflicts
among policy classifications. To this end, the majority devotes pages
to defining the classifications to which it might assign the policies and
how each classification might change with the inclusion of a different
type of "other-insurance" clause. The generalized classifications identified by the majority include: "a primary policy," "an excess policy,"
"policies with other insurance clauses taking the form of a pro-rata
clause, an escape clause, or an excess clause," "a primary liability
insurance policy that contains an excess other-insurance clause," "a
coincidental excess policy," "a true excess or pure excess policy," and
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III
The policies in this case were issued against the statutory backdrop
of the West Virginia Code, which requires specified insurance for
school systems and public school employees. In West Virginia, all
county boards of education are required by law to have at least $1
million of primary liability insurance coverage and $5 million of
excess coverage. See W. Va. Code 29-12-5a. In particular, the statute requires that the West Virginia Board of Risk and Insurance Management purchase such insurance on behalf of all boards of education
and their employees, and it requires that the county school boards pay
the premiums for the excess policy. Id. 29-12-5a(c). Moreover, each
insurance company providing insurance under this mandate must be
licensed to do business in West Virginia. Id. For the Lincoln County
Board of Educations 2002-2003 school year, the statutorily required
insurance package consisted of a primary policy issued by National
Union, covering losses up to $1 million, and an excess policy issued
by General Star, covering losses greater than $1 million, up to an
additional $5 million. For persons in the education and insurance
fields in West Virginia, these requirements were well known and well
understood.
Recognizing this system of mandated insurance, the West Virginia
Education Association obtained a supplemental policy from Horace
Mann, which provided personal coverage for the members of the
Association, including the school principal in this case. The Horace
Mann policy explicitly stated that it was a low-cost policy providing
personal protection to members over and above the state-mandated
insurance for public school employees.
In this case, after National Union paid its policy limits to settle
with the parents of the abused student and General Star paid the
remainder of the settlement amount, General Star sought to obtain
reimbursement for the amounts it paid from Horace Mann. Horace
Mann denied that it had a duty to reimburse General Star because its
policy was excess over General Stars policy, and it commenced this
action seeking a declaratory judgment that its coverage was excess
over General Stars policy and that General Stars policy limits had
to be exhausted before Horace Mann would become obligated to contribute any amount. In response, General Star counterclaimed for a
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